Clinical interpretation: The hermeneutics of medicine

I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. The literary critic reading a novel, the judge asked to apply a law, must arrive at a coherent reading of their respective texts. Similarly, the physician interprets the text of the ill person: clinical signs and symptoms are read to ferret out their meaning, the underlying disease. However, I suggest that the hermeneutics of medicine is rendered uniquely complex by its wide variety of textual forms. I discuss four in turn: the experiential text of illness as lived out by the patient; the narrative text constituted during history-taking; the physical text of the patient's body as objectively examined; the instrumental text constructed by diagnostic technologies. I further suggest that certain flaws in modern medicine arise from its refusal of a hermeneutic self-understanding. In seeking to escape all interpretive subjectivity, medicine has threatened to expunge its primary subject — the living, experiencing patient.     

Medical hermeneutics: Where is the “text” we are interpreting?

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty.     

Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

驾驶员心理品质检测中的杆型人形图法

在汽车驾驶员心理品质检测研究中,我们根据数学中的多变量图分析方法,并汲取简笔画的优点,用19个人形图变量代表检测所得的17种心理品质数据,来具体、形象地再现每个驾驶员心理品质变量的整体关系。这对于检测结果的分类或进行系统化分析具有重要的实用意义。     

Pediatric Psychology: Child Psychological Health in the Next Century

The future of pediatric psychology is reviewed and placed in brief historical context in relation to children's psychological health care. Contemporary trends affecting the delivery of psychological services, research, and clinical training are highlighted, with suggestions for future development. Pediatric psychology is a child-based, developmentally-focused multidisciplinary practice directed toward psychosocial and neuropsychological issues of health and illness in children and youth. Pediatric psychologists need to develop strong professional identities as health care psychologists combined with a collegial and collaborative arrangement with physicians to ensure the future growth and development of pediatric psychology in the next century as a major vehicle to promote children's health care.     

Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

Latinas with Arthritis: Effects of Illness, Role Identity, and Competence on Psychological Well-Being

Tested a theoretical model on the effects of social role identity, illness intrusion, and competence on psychological well-being among 109 low-income Latinas with arthritis. All six roles studied were rated as highly important identities. Sex-role nontraditionalism was associated with less importance of the homemaker, mother, and grandmother roles. Negative affect increased as a function of intrusions into valued identities. Having important role identities contributed to feelings of competence (i.e., self-esteem and self-efficacy), which in turn, contributed to psychological well-being. Competence also mediated the effects of pain, identity, and illness intrusions on psychological well-being. Results suggest competence processes play an important role in well-being.     

Effects of Self-Correction on the Acquisition, Maintenance, and Generalization of the Written Spelling of Elementary School Children

We examined the effect of self-correction on the acquisition, maintenance, and generalization of written spelling of elementary school students attending an after-school clinic. Six students registered for remedial tutoring participated. During self-correction, students initially learned four proofreading marks and a procedure for using them that were subsequently applied as the students compared their spelling to a model. Results showed a functional effect between self-correction and improved student performance on target words. Using the self-correction procedure, the students spelled at least 98% of the target words accurately, maintained at least 85% of the correctly spelled words, and generalized at least 70% of the words at home, in context, and with word variations. Questionnaires administered to the students, their parents, and teachers indicated that students preferred self-correction. Parents noticed academic improvements in their child's spelling performance as well as positive changes in attitude toward school. Most teachers did not notice changes in spelling performance or attitude.     

Self as the feminine principle

In analytical psychology, ego is associated with consciousness and the masculine principle. Although die feminine principle generally characterizes the unconscious, it was not assigned a psychic structure equivalent to the ego. This paper proposes a model of the psyche where self and ego are the major modes of psychic experience. The self as the 'being' mode represents the feminine principle and functions according to primary process; the ego represents 'doing', the masculine principle and secondary process. Feminine and masculine principles are considered to be of equal significance in both men and women and are not limited to gender.
Jung's concept of the self is related to the Hindu metaphysical concepts of Atman and Brahman, whose source was the older Aryan nature-oriented, pagan religion. The prominence of self in analytical psychology and its predominantly 'feminine' symbolism can be understood as Jung's reaction to the psychoanalytic emphasis on ego and to Freud's 'patriarchal' orientation. In Kabbalah, a similar development took place when the feminine principle of the Shekinah emerged in a central, redemptive role, as a mythic compensation to the overtly patriarchal Judaic religion.
In the proposed model of the psyche neither ego nor self represents the psychic totality. The interplay of both psychic modes/principles constitutes the psyche and the individuation process.     

Cultural orientation and psychological well-being in Chinese Americans

Examined cultural orientation in the domains of language proficiency, cultural activity, and social relationship, and its relationship with psychological well-being in a group of 143 Chinese Americans in San Francisco. Four indicators of psychological well-being were utilized, two assessing the experience of distress (depression level and negative affect) and two assessing positive well-being (positive affect and life satisfaction). Domain-specific cultural orientations were found to hold differential relationships with psychological well-being. For instance, bicultural activity orientation predicted the best psychological well-being (regardless as to how it was assessed), but socially separatist individuals experienced less negative affect than assimilated and bicultural respondents. Findings were discussed in the context of the multicultural setting of San Francisco. It is suggested that future research retain separate assessments of domain-specific cultural orientation, examine the contribution of the community's ethnic/cultural composition to its members' cultural orientations (i.e., address the role of person-environment fit) and study their impact on psychological well-being. The data reported here were collected as part of the author's doctoral dissertation. Ricardo F. Munoz and Guillermo Bernal guided and supported the implementation of this study; Sunwoo Lee assisted with the data analysis; and Edison J. Trickett and the anonymous reviewers offered helpful suggestions.